Please Type to Complete This Form

Name

Address

City State Zip

Phone Number E-Mail

Club Affiliation

Year: Color:

Generation Entering: C1 / C2 / C3 / C4 / C5 / C6 / C7

Style of Corvette: Convertible / Coupe / Fixed Coupe / ZR1 / Z06

Dash Plaques to the first 75 Entries – Shirts While They Last

Pre-Registered Entrants are eligible for a separate $100 drawing Early registration due by April 26, 2014.

Please indicate shirt size: S M L XL 2XL 3XL

Additional Show T-Shirts: Yes Please Add $15.00 per T-Shirt Quantity by Size: () S ( )M ( )L ( ) XL ( )2XL ( )3XL

Signed Date

Registration fee — $25.00 www.tricitiescorvetteclub.com

Make checks payable, and mail to: Tri-Cities Corvette Club Pat Ball, Secretary 403 Old Abingdon Highway • Bristol, VA 24201